Oesophageal atresia and/or tracheo-oesophageal fistula ... a study of mortality.

Four hundred and fifteen babies with oesophageal atresia and/or tracheo-oesophageal fistula were admitted to the Royal Children's Hospital, Melbourne during the thirty year period, 1948--1977. Three hundred and fifty-six had proximal oesophageal atresia with a distal tracheo-oesophageal fistula; one of this group also had a proximal fistula. Three hundred twenty-eight were managed surgically with two hundred forty survivals. Factors affecting mortality in this group have been analysed and their therapeutic implications considered. There was a 50% mortality in the babies, numbering six in all, with proximal oesophageal atresia with a proximal tracheo-oesophageal fistula, but only one of the deaths in this group was regarded as being avoidable. Thirty-two babies had oesophageal atresia without an accompanying fistula, and in this group there was a relatively high mortality which was multi-factorial. In particular, factors included the association of this type of atresia with other anomalies incompatible with life, prematurity and technical problems. Twenty-one babies had an isolated "H" tracheo-oesophageal fistula with two deaths; one was a very early death reflecting the problems of neonatology a quarter of a century ago. The other died of a recurrent tracheo-oesophageal fistula and subsequent complications, and it is believed that this death would have been avoided by the present day approach.